Lauren Waterman on the value of an ED doctor.

Social media allows the journal to communicate with our readership in a way that is more rapid than in print, or even on our online first pages. A good example is a letter received this week. Lauren Waterman asks us what the true value of an EM consultation is following suggestions that patients should be charged for their attendance.

We think the best way to answer this is to share with the readership and to ask for your comments via twitter using our twitter address @EmergencyMedBMJ

So, read on and tell us what you think.

Simon Carley

Social media editor EMJ

So, Doctor, was I worth £10?

Dear Editor,

I am writing this letter in response to the recent survey which showed a third of general practitioners to support patient fees for ‘unnecessary’ A&E visits1. The idea is that patients would be charged £5-£10 and this refunded if doctors deemed the visit appropriate. I propose three key reasons why this charge would be impractical, unethical and dangerous.

Firstly, A&E doctors would have to get into discussions with patients as to why their payment cannot be refunded. These discussions will be awkward for the doctors to have, impact upon the doctor-patient relationship and also take up the doctors’ time, where resources are what we are trying to save in the first place.

Secondly, it stops the NHS being ‘free at the point of care’ which is a fundamental feature of its constitution. This may defer certain lower-economic patient groups (those groups that may have less education about heath and illness in the first place) from presenting to A&E when something may actually be wrong.

Thirdly, when a patient presents to A&E they do not wait in a busy waiting room for fun! They believe that something needs urgent medical attention. This intervention would not educate patients, as it is unlikely that doctors would have time to fully explain why a patient’s visit was justified or not. There would be discrepancy between different doctors in what they believe to be a ‘legitimate visit’, with some willing to refund for certain presentations that others believe to be ‘not warranting a visit’. This would confuse patients further and not help them to make ‘better decisions’ the next time.

To conclude, although vast costs are incurred by patients that attend A&E without requiring urgent treatment2, charging patients is not the answer. Patients who are without extensive medical knowledge are not trained to know when symptoms signify something sinister. However, perhaps further educational intervention that teaches the public more about the different options available to them would help to direct them to the right place.